RD&E Members Meeting – September 2017

RD&E Members’ Day & Annual Members’ Meeting 2017

3.00-7.00pm Wednesday 27th September 2017

RILD Centre, RD&E Hospital, Exeter EX2 5DW

Meeting attended by Carol Hayes for www.offwell.org

To read the full Annual Report and Accounts 2016/17 go to:

www.rdemembers.com

‘Key Publications and Useful Links’

There were two presentations on the day:

1 – Stroke Care Present & Future

2  – Improving Care at Home and in Communities 

Stroke Care Present & Future

Dr. Martin James, Clinical Lead for the Stroke Service at RD&E

Recent development in the care and treatment of people with stroke, particularly in relation to new national guidelines for stroke victims, published in autumn 2016, has seen a 30% reduction in mortality rates (during first 30 days)  plus a 46% reduction in patients needing institutionalisation and 49%  reduction in length of stay in Hospital.

The RD&E has become the first acute hospital in the South West to achieve a grade ‘A’ score for its stroke care since the national stroke audit began in 2013.

In the UK stroke is the most common serious neurological disease and a leading cause of death. There are more than 1.2 million stroke survivors of whom more than 50% have a disability so improving outcome from stroke is a key healthcare priority. About 80% of acute strokes are ischaemic, mainly from large vessel occlusion due to either artery-to-artery embolism (clot) or cardiac embolism. Early treatment is critical to rescue potentially salvageable tissue (‘time is brain’).

Thrombectomy (using stent retriever devices to retrieve the clot from the artery) must be performed within the first few hours after the stroke. The sooner the patient receives treatment the better the prognosis. RD&E aim for a ‘door to needle’ time (Hospital) of 45 minutes. All major south west hospitals have this stroke protocol but more stroke specialists are needed and, as with everything, there is something of a postcode lottery. Plymouth (Derriford) has more stroke consultants than RD&E (Wonford).

In the winter months the Hospital is under extra pressure and it can be harder for staff to get patients to the stroke unit quickly enough. Mortality rates can also depend on the number of nurses on duty in the stroke unit at weekends. The ‘best’ time to have a stroke is on a Friday afternoon, the ‘worst’ time on a Monday morning.

The future for stroke care is better survival and less disability.

Prevention:

Improving control of high blood pressure and detecting those people with irregular pulse rates.

For more information on ischaemic stroke care and mechanical thrombectomy go to:

www.pn.bmj.com  Practical Neurology – Revolution in acute ischaemic stroke care: a practical guide to mechanical thrombectomy.

Review: 1st July 2017

For more information on national stroke data go to:

www.strokeaudit.org  Sentinel Stroke National Audit Programme (SSNAP)

At 80% the RD&E has one of the highest performance ratings in the country. Only Kings College, London, rates higher.

Improving Care at Home and in Communities

Dr. Jayne Govier  (Exeter GP) and Dr. Anthony Hemsley (Geriatrician)

Implemented in March 2017 this presentation covered developments around efforts to provide more care at home and in communities. This is part of a move towards a new system of care that proactively promotes people’s wellbeing and independence and seeks to avert health crises. The work is being done in partnership with communities, individuals and health and care organisations.

Dr. Hemsley reported on the challenges faced by a population increase and a growing elderly population with complex health and care needs.

At present we are reliant on an event based model of care and on the day of the Members Meeting there were 90 patients in RD&E beds who didn’t need to be in Hospital.

Dr. Hemsley went on to talk about the co-operation between health care and community services, mental health, social services and voluntary services. Unfortunately there was no evidence from the non-clinical sector about how this ‘co-operation’ was working in practice.

There is now a Community Connect number – a single point of access, but again no details on how this is working. There are six Urgent Community Response functions across the Eastern Section. Geriatricians are allocated to localities to support teams with an increase in clinical and support worker resources. References were made to Discharge to Assess principles, with assessment in the patient’s home, plus rapid access to specialist opinion and diagnosis.

Sadly, there was no time allotted for clarification on how any of the above was working or could work. Therefore I can give no real assessment on what is in place, how ‘health crises’ are to be averted when there are part-time GPs who are less likely to be familiar with their patients’ circumstances and with a care system in crisis.

There was no answer to my question: “If these provisions have been in place for over six months why is it that the RD&E, today, has 90 patients in beds who don’t need to be in Hospital?”

The 100,000 Genomes Project

The project aims to sequence 100,000 whole genomes from about 70,000 people. Participants are NHS patients with certain types of cancer and patients with rare disease plus their families.

The aims of the project are: improving care for patients; setting up an NHS genomic medicine service; to gain new insights and understanding about the causes of disease for future generations and to kickstart a UK genomics industry.

Families affected by rare conditions or cancer across the South West are having their genomes sequenced as part of a national bid to shed new light on the genetic causes of disease.

Since launching in 2014, the South West NHS Genomics Medicine Centre (SWGMC) has enrolled 372 patients with a rare disease, or cancer, for genome sequencing to understand more about their condition. Nearly 4,000 samples will be provided by hospitals across the South West.

For more information about the South West Genomics project go to:

www.swgmc.org  or email rde-tr.swgmc@nhs.net 

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